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� PERMIT APPLICATION � <br /> I CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810—FAX 425-257-8857—www.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4�M <br /> I SITE ADDRESS PARCEL TAX I.D.# PE MIT#� <br /> � �-: � �'� o0N3Fnn.> �C <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESG �3'w iv 3ti6 EV�aF7� n�v L <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �?CcrJr� �3Fr1�F �/�ifR�' Cf�'Fi7CJ-3fNEF 1'7-75 NCt7ri✓F F.�F<eT 5�'�."; G'15-?69-lys'� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> O.r+E"� � <br /> CONTRACTOR CAQ���l C�,�;�i;ClT�D��t/ ADDRESS CITY2IP PHONE II <br /> N�'i Rc�K��,F LE"R f�� Ed�i2Fn; c✓f" 5 Sf C'j <br /> CONTR.IICENSE# C.?/�r�C�1F /�/H"}�� � - n- � - <br /> �Z�C%S' v� S , 1�- ;C��< <br /> USE OF BUILDING HEAT OURCE CONTRACT PRICE OF WORK <br /> � l/.�'C-L E F-,`i'CY <br /> � r�s�f�����.f- _Eledric Gas_Other <br /> WORK DESCRIPTION /!/fCHC�J j(S�ifli�L.^t;.✓,�RY ti'E:+'i"L'EG- / bL��T!C�J ; �(,.;cliS,N E�'/iTi�J� <br /> i;✓;ERi�;? Kit�nENi[iATH/C••u,-��i1y O�'E� �.Jo F:�7cRiCR �r✓r2co P.FTiC�. �.�Ns��?�� ' <br /> I .n/C�J if���r1E:i�A•�TN�C/,'�;.�pn'Y A.✓' G,rR�':�:� �ifN /,S'C� S.F. ADD�Tic^�� i,'V <br /> r"L'L.6 C'f� f=l�'^%'!�: lJ✓r-i_'EiJ h�ll ic'. <br /> ' PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N0. TYPE OF FIxTURE OR ITEM I <br /> Toilet A/C-air handling units <br /> Bathtub J_ Forced air systems I <br /> T Lavatory(wash basin) 1 Gas piping <br /> � Shower _ Water heater <br /> � Kitchen sink 8 disposal Gas freplace <br /> Dishwasher � Gas range <br /> � Clothes washer —� Clothes dry?r <br /> Laundry tray � Range hood <br /> , I Sink(servicelbadmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _j Boiler <br /> i _ Floordrain � Refrigeralion <br /> Grease trap _ Woodslove <br /> _ Roof drains _ Other i <br /> i Other — <br /> — -- I <br /> ICITY OF EVERETT LOCAL SALES TAX COOE IS J105 <br /> II I hereby ceritify Ihat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> oNinaces goveming this type of work�vill be complied with whether specifizd herein or noL The granting of a pertnit does not presume � <br /> to give a:dhoriry to violate or cancel lhe provision of any other sWte or lowl law regulaling consWction or the pedormance of <br /> construction.That I am authorized by the owner of this property to pedorm the work for which appliration is made and I comply wilh the <br /> State Cont/raUors.Law 1827 RCW and296200 WAG � <br /> / / ., " _. . � . . . � <br /> � ignatare of OwnedConlrectodAulhonzed Agent . Date <br /> �/� <br />